| Objective:In this study, by useing signle beat real-time dimensionalechocardiography we assess the impact of right/left ventricular end-diastolicdiameter ratio in connective tissue disease with pulmonary arterialhypertension on left ventricular systolic function and movementSynchrony.Methods:1Object: The control group consisted of31volunteer (21females,agedfrom23to52,mean33.19±1.42) who had no heart organic disease basesedon physical examintion, laboratory investigation,electrocardiogram andechocardiography,and had no risk factors fo hypertension or coronary heartdisease. The range of right/left ventricular end-diastolic diameter ratio(RV/LV)in this group was from0.30to0.51and the mean was0.40±0.01.The casesconsisted of31patientes(21males,aged from18to54,mean30.1±1.53) whohad been previously diagnosed connective tissue disease (CTD) withpulmonary arterial hypertension.The diagnosis was basesed on medicalhistory,clinical signs and symptoms, andnoninvasive procedures (ECG, UCG,CT, MRI) without congenital heart disease, pulmonary embolism, connectivetissue diseases,and other diseases which can increase pulmonary arterypressure. Those cases were divided into two subgroups according to right/leftventricular end-diastolic diameter ratio.A Group: RV/LV＜0.84(18cases);BGroup: RV/LV≥0.84(13cases).2Echocardiography:2.1The diagnosis of pulmonary hypertension: Pulmonary artery systolicblood pressure(SPAP)≥40mmHg. Echocardiography evaluation method ofpulmonary artery pressure:tricuspid regurgitation pressure differential method. Pulmonary artery systolic blood pressure=Right atrial pressure(RAP)+Pulmonary valve regurgitation differential pressure (△P). If the right atriumwas normal size the right atrial pressure (RAP) approximately to5mmHg;when the right atrium size increased mildiy the right atrial pressure (RAP)approximately to10mmHg; when the right atrium increased obviously theright atrial pressure (RAP) approximately to15mmHg. Right atrial sizemeasurements: in the XinJian. Four-chamber view measured the right atrialmaximum diameter in end systolic or diastolic early. IF the diameter above40mm,we considered that the right atrium size increased mildiy, if thediameter above50mm,we considered that the right atrium size increasedobviously.2.2Calculation method of right/left ventricular end-diastolicdiameterratio(RV/LV) and signle beat real-time dimensional echocardiography imagecollection method：Echocardiographic examination was performed by Siemens Acuson SC2000echocardiogram equiped with4V1c and4Z1c probes,and LV Analysissoftware. Echocardiographic data were acquired form patients who connectedelectrocardiogram in the left recumbent positions by4V1c probes. Rightventricular end-diastolic diameter (RVEDD) and left ventricular end-diastolicdiameter (LVEDD) were obtained by a line which perpendicular to the leftventricular long axis, at the end of diastole, in parasternal views at the level ofmitral chordae. First acquired the best image on the long axis in apical fourchamber view by4Z1c probes in two-dimensional pattern and then went tofour-dimensional pattern and stored three cardial cycles image. Next analysisthe four-dimensional images we had stored with LV Analysis software.Echocardiogram can sketch endocardium automatically and adjust the curveappropriately,then left ventricular end-diastolic volume(EDV),end-systolicvolume(ESV), stroke volume(SV), ejection fraction (EF) and time-volumecurve were achieved.Among those parameters the time-volume curve hadgived,we chose systolic dyssynchrony index (SDI),distolic dyssynchronyindex(DDI),mean contraction time(MES)and mean relaxation time(MED) to evaluate the left ventricular movement synchrony.Results:1Right Ventricular End-Diastolic Diameter (RVEDD):①Group A, Bcompared with the control increased significantly(P <0.01);②Group Bincreased significantly (P <0.01) compared with group A.2Left Ventricular End-Diastolic Diameter (LVEDD):①Group Bdecreased(P <0.05) compared with group A and the control;②Group A decreasedcompared with the control (P＞0.05).3Right/left ventricular end-diastolic diameter ratio (RV/LV):①GroupA, B compared with the control increased significantly(P <0.01);②Group Bincreased significantly (P <0.01) compared with group A.4Left ventricular end-diastolic volume(EDV):①Group B decreasedsignificantly(P <0.01) compared with the control; group A decreasedcompared with the control (P<0.05);②Group B decreased significantly (P <0.01) compared with group A.5Left ventricular end-systolic volume(ESV), stroke volume(SV), andejection fraction (EF):①Group B decreased significantly (P <0.01)compared with group A and the control;②Group A decreased compared withthe control (P＞0.05).6RV/LV and LVEF linear correlation analysis in GroupB: r=-0.94(P＜0.01).7Left ventricular systolic dyssynchrony index (SDI) and distolicdyssynchrony index(DDI):①Group A, B compared with the controlincreased significantly(P <0.01);②Group B increased significantly (P <0.01)compared with group A.8Mean contraction time(MES)and mean relaxation time(MED): thosewere no no statistical significance between each group.9RV/LV and SDI linear correlation analysis in the cases: r=0.89,P＜0.01.RV/LV and DDI linear correlation analysis in the cases: r=0.87,P＜0.01. Conclusion1Pulmonary hypertension caused by connective tissue disease withpulmonary artery pressure increased continuously, right/left ventricularend-diastolic diameter ratio (RV/LV) increased, left ventricular systolicfunction will be affected, and compared with normal existence ejectionfraction decline(P＜0.01).2Right/left ventricular end-diastolic diameter ratio(RV/LV)≥0.84canpredicte left ventricular systolic function reduce in connective tissue disease.3In pulmonary arterial hypertension patients caused by connectivetissue disease left ventricular movement synchrony were related to Right/leftventricular end-diastolic diameter ratio (RV/LV), as the ratio increased leftventricular movement synchrony decreased both in systolic and diastolic. |
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